Abstract：
This work used software-guided radiographic measurement to assess the effects of progressive lateral column lengthening (LCL) on restoring alignment in a novel cadaveric model of stage II-B flatfoot deformity.
A stage II-B flatfoot was created in 8 cadaveric specimens by transecting the spring ligament complex, anterior deltoid, and interosseous talocalcaneal and cervical ligaments. Weightbearing computed tomographic (WBCT) scans were performed with specimens under 450 N of compressive load in the intact, flat, and 6-, 8-, and 10-mm lateral column-lengthening conditions. Custom software-guided radiographic measurements of the lateral talo-first metatarsal (Meary) angle, anteroposterior talo-first metatarsal angle, naviculocuneiform overlap, and 2 new measures (plantar fascia [PF] distance and angle) were recorded on digitally reconstructed radiographs. Four anonymized analysts performed measurements twice. Intra- and interobserver agreement was assessed using intraclass correlation coefficients (ICCs).
Six-millimeter LCL restored alignment closest to the intact foot in this new cadaveric model, whereas 10-mm lengthening tended toward overcorrection. The PF line displaced laterally in the flatfoot condition, and LCL restored the PF line to a location beneath the talonavicular joint. Interobserver agreement was excellent for PF distance (ICC = 0.99) and naviculocuboid overlap (ICC = 0.91), good for Meary angle (ICC = 0.81) and PF angle (ICC = 0.69), and acceptable for the talonavicular coverage angle (ICC = 0.65).
In this stage II-B cadaveric flatfoot model, cervical ligament transection was essential to create deformity after the medial hindfoot ligaments were transected. Software-guided radiographic measurement proved reliable; standardized implementation should improve comparability between studies of flatfoot deformity. The novel PF distance performed most consistently (ICC = 0.99) and warrants further study. With this model, we found that a 6-mm LCL restored alignment closest to the intact foot, whereas 10-mm lengthening tended toward overcorrection.
Future joint-sparing flatfoot corrections may consider using a relatively small LCL combined with other bony and/or anatomic ligament/tendon reconstructions.
A stage II-B flatfoot was created in 8 cadaveric specimens by transecting the spring ligament complex, anterior deltoid, and interosseous talocalcaneal and cervical ligaments. Weightbearing computed tomographic (WBCT) scans were performed with specimens under 450 N of compressive load in the intact, flat, and 6-, 8-, and 10-mm lateral column-lengthening conditions. Custom software-guided radiographic measurements of the lateral talo-first metatarsal (Meary) angle, anteroposterior talo-first metatarsal angle, naviculocuneiform overlap, and 2 new measures (plantar fascia [PF] distance and angle) were recorded on digitally reconstructed radiographs. Four anonymized analysts performed measurements twice. Intra- and interobserver agreement was assessed using intraclass correlation coefficients (ICCs).
Six-millimeter LCL restored alignment closest to the intact foot in this new cadaveric model, whereas 10-mm lengthening tended toward overcorrection. The PF line displaced laterally in the flatfoot condition, and LCL restored the PF line to a location beneath the talonavicular joint. Interobserver agreement was excellent for PF distance (ICC = 0.99) and naviculocuboid overlap (ICC = 0.91), good for Meary angle (ICC = 0.81) and PF angle (ICC = 0.69), and acceptable for the talonavicular coverage angle (ICC = 0.65).
In this stage II-B cadaveric flatfoot model, cervical ligament transection was essential to create deformity after the medial hindfoot ligaments were transected. Software-guided radiographic measurement proved reliable; standardized implementation should improve comparability between studies of flatfoot deformity. The novel PF distance performed most consistently (ICC = 0.99) and warrants further study. With this model, we found that a 6-mm LCL restored alignment closest to the intact foot, whereas 10-mm lengthening tended toward overcorrection.
Future joint-sparing flatfoot corrections may consider using a relatively small LCL combined with other bony and/or anatomic ligament/tendon reconstructions.
摘要：
这项工作使用软件引导的射线照相测量来评估渐进式侧柱延长（LCL）对II-B期平足畸形的新型尸体模型中恢复对齐的影响。
通过横切弹簧韧带复合体，在8个尸体标本中创建了II-B期扁平足，前三角肌,和骨间骨和颈韧带。在完整的450N压缩载荷下，对标本进行了称重计算机断层摄影（WBCT）扫描，扁平,和6-，8-,和10毫米横向柱加长条件。自订软件引导的横向距骨第一跖骨（Meary）角度的射线照相测量，前后距骨-第一跖骨角,Naviculocuneform重叠，并在数字重建的射线照片上记录了2种新的措施（足底筋膜[PF]距离和角度）。四名匿名分析师进行了两次测量。使用组内相关系数(ICC)评估观察者之间的一致性。
在这个新的尸体模型中，六毫米LCL恢复了最接近完整脚的对齐方式，而10毫米的加长倾向于过度矫正。PF线在平足状态下横向移位，LCL将PF线恢复到距骨关节下方的位置。观察者之间的一致性对于PF距离（ICC=0.99）和naviculocuboid重叠（ICC=0.91）非常好，适用于Meary角（ICC=0.81）和PF角（ICC=0.69），并且对于距骨覆盖角(ICC=0.65)是可接受的。
在这个阶段II-B尸体平足模型中，横切后足内侧韧带后，颈椎韧带横切对于形成畸形至关重要。软件引导的射线照相测量被证明是可靠的；标准化的实施应提高平足畸形研究之间的可比性。新的PF距离表现最一致（ICC=0.99），值得进一步研究。有了这个模型，我们发现一个6毫米的LCL恢复对齐最接近完整的脚，而10毫米的加长倾向于过度矫正。
未来的关节保留平足矫正可能会考虑使用相对较小的LCL结合其他骨和/或解剖韧带/肌腱重建。
通过横切弹簧韧带复合体，在8个尸体标本中创建了II-B期扁平足，前三角肌,和骨间骨和颈韧带。在完整的450N压缩载荷下，对标本进行了称重计算机断层摄影（WBCT）扫描，扁平,和6-，8-,和10毫米横向柱加长条件。自订软件引导的横向距骨第一跖骨（Meary）角度的射线照相测量，前后距骨-第一跖骨角,Naviculocuneform重叠，并在数字重建的射线照片上记录了2种新的措施（足底筋膜[PF]距离和角度）。四名匿名分析师进行了两次测量。使用组内相关系数(ICC)评估观察者之间的一致性。
在这个新的尸体模型中，六毫米LCL恢复了最接近完整脚的对齐方式，而10毫米的加长倾向于过度矫正。PF线在平足状态下横向移位，LCL将PF线恢复到距骨关节下方的位置。观察者之间的一致性对于PF距离（ICC=0.99）和naviculocuboid重叠（ICC=0.91）非常好，适用于Meary角（ICC=0.81）和PF角（ICC=0.69），并且对于距骨覆盖角(ICC=0.65)是可接受的。
在这个阶段II-B尸体平足模型中，横切后足内侧韧带后，颈椎韧带横切对于形成畸形至关重要。软件引导的射线照相测量被证明是可靠的；标准化的实施应提高平足畸形研究之间的可比性。新的PF距离表现最一致（ICC=0.99），值得进一步研究。有了这个模型，我们发现一个6毫米的LCL恢复对齐最接近完整的脚，而10毫米的加长倾向于过度矫正。
未来的关节保留平足矫正可能会考虑使用相对较小的LCL结合其他骨和/或解剖韧带/肌腱重建。
